BALLANCE and Duel in 19321 published their famous paper on the surgery of the facial nerve; in cases of Bell's palsy which did not disappear spontaneously they advocated a decompression of the facial nerve from the stylomastoid foramen to the lateral semicircular canal, a modus operandi which today is generally accepted when it is performed on the right indications.
As described by Kettel,2 and recently also by Hilger3 and Sullivan,4 Bell's palsy is in all probability a pathogenic entity, the primary and central feature of which is a "dysregulation" of the circulation which probably takes place near the stylomastoid foramen causing an ischemic paralysis. The consequence of the lack of blood supply to the nerve is edema with subsequent degenerative changes; the nerve is thus compressed in its bony canal, which causes further impairment of the vascular blood supply, so that a vicious circle arises, the
HALL A. PATHOLOGY OF BELL'S PALSY. AMA Arch Otolaryngol. 1951;54(5):475–477. doi:10.1001/archotol.1951.03750110011003